What is the recommended course of action for a woman with persistent lack of Measles, Mumps, and Rubella (MMR) immunity despite repeated vaccinations?

From the Guidelines

For a woman with persistent lack of Measles, Mumps, and Rubella (MMR) immunity despite repeated vaccinations, the recommended course of action is to administer one more dose of the MMR vaccine, after which she should be considered protected regardless of subsequent antibody test results. This recommendation prioritizes the reduction of morbidity and mortality associated with measles, mumps, and rubella, while also considering the quality of life for the individual by minimizing unnecessary vaccinations and testing. The standard MMR vaccine dose is 0.5 mL administered subcutaneously 1. Some individuals may not develop measurable antibody levels despite being protected against disease, a phenomenon known as "non-responder" status, which occurs in approximately 1-5% of individuals 1. The protection against measles, mumps, and rubella is likely conferred through cell-mediated immunity rather than humoral (antibody) immunity in these cases. Key considerations include:

• The woman's vaccination history and previous responses to MMR vaccinations
• The potential risks and benefits of additional vaccinations
• The importance of counseling the woman on her immune status and the implications for her health and the health of those around her
• The need for ongoing monitoring and evaluation of vaccination strategies to ensure optimal protection against measles, mumps, and rubella. It is essential to note that the administration of immune globulins can interfere with the immune response to MMR vaccine, and therefore, the timing of vaccination should be carefully considered in relation to the administration of such products 1. Ultimately, the goal is to provide the woman with the best possible protection against measles, mumps, and rubella while minimizing unnecessary interventions and promoting her overall health and well-being.

From the Research

Recommended Course of Action

For a woman with persistent lack of Measles, Mumps, and Rubella (MMR) immunity despite repeated vaccinations, the following points are relevant:

• A third dose of MMR vaccine may be beneficial in improving immunity against mumps and rubella, as shown in studies 2, 3, 4, 5.
• The third dose of MMR vaccine has been found to increase antibody levels against mumps and rubella, which may provide protection against these diseases for a longer period 2, 4, 5.
• Individuals with low baseline antibody levels may benefit the most from a third dose of MMR vaccine, as they are more likely to experience a significant boost in antibody titers 4, 5.
• The immunogenicity of the rubella component of the MMR vaccine has been found to be robust after a third dose, with a significant increase in neutralizing antibody titers 5.
• A second dose of MMR vaccine has been found to significantly reduce the proportion of individuals with negative or equivocal antibody levels to one or more antigens, but continued monitoring of long-term population protection is required 6.

Key Findings

• A third dose of MMR vaccine can increase antibody levels against mumps and rubella, providing protection against these diseases for a longer period 2, 4, 5.
• Individuals with low baseline antibody levels are more likely to benefit from a third dose of MMR vaccine 4, 5.
• The rubella component of the MMR vaccine has been found to be immunogenic after a third dose, with a significant increase in neutralizing antibody titers 5.
• Continued monitoring of long-term population protection is required, as antibody levels may decline over time 6.